White Rock Medical Center

All Charges

Charge

Type

Setting

Price

SUTURE, COATED VICRYL VIL BR 3-0 CLOSURE 27'''' CT-1 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COATED VICRYL VIL BR 3-0 G.I. 27'''' SH -- DHF

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, COAT VCRYL VIL BR 3-0 G I 8-18 CRSH RLY PK -- DHF

Facility

$257.57

Hospital Charge Code	81944902
Hospital Revenue Code	272
Min. Negotiated Rate	$23.18
Max. Negotiated Rate	$167.42
Rate for Payer: Aetna Commercial	$141.66
Rate for Payer: Amerigroup CHIP/Medicaid	$23.18
Rate for Payer: BCBS of TX Blue Advantage	$77.27
Rate for Payer: BCBS of TX Blue Essentials	$92.73
Rate for Payer: BCBS of TX PPO	$103.03
Rate for Payer: Cash Price	$226.66
Rate for Payer: Multiplan Auto	$167.42
Rate for Payer: Multiplan Commercial	$167.42
Rate for Payer: Multiplan Workers Comp	$167.42
Rate for Payer: Scott and White EPO/PPO	$128.78
Rate for Payer: Superior Health Plan EPO	$35.03

SUTURE, COAT VICRYL UND BR 0 CLOSURE 27'''' CT-1 -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COAT VICRYL UND BR 0 LIGAPAK 54'''' -- DHF

Facility

$142.72

Hospital Charge Code	81943706
Hospital Revenue Code	272
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$92.77
Rate for Payer: Aetna Commercial	$78.50
Rate for Payer: Amerigroup CHIP/Medicaid	$12.84
Rate for Payer: BCBS of TX Blue Advantage	$42.82
Rate for Payer: BCBS of TX Blue Essentials	$51.38
Rate for Payer: BCBS of TX PPO	$57.09
Rate for Payer: Cash Price	$125.59
Rate for Payer: Multiplan Auto	$92.77
Rate for Payer: Multiplan Commercial	$92.77
Rate for Payer: Multiplan Workers Comp	$92.77
Rate for Payer: Scott and White EPO/PPO	$71.36
Rate for Payer: Superior Health Plan EPO	$19.41

SUTURE, COAT VICRYL VIL BR 0 G.I. 18'''' V-38,V-38 -- DHF

Facility

$250.52

Hospital Charge Code	81943458
Hospital Revenue Code	272
Rate for Payer: Cash Price	$220.46

SUTURE, COAT VICRYL VIL BR 0 G.I. 18'''' V-38,V-38 -- DHF

Facility

$250.52

Hospital Charge Code	81943458
Hospital Revenue Code	272
Min. Negotiated Rate	$22.55
Max. Negotiated Rate	$162.84
Rate for Payer: Aetna Commercial	$137.79
Rate for Payer: Amerigroup CHIP/Medicaid	$22.55
Rate for Payer: BCBS of TX Blue Advantage	$75.16
Rate for Payer: BCBS of TX Blue Essentials	$90.19
Rate for Payer: BCBS of TX PPO	$100.21
Rate for Payer: Cash Price	$220.46
Rate for Payer: Multiplan Auto	$162.84
Rate for Payer: Multiplan Commercial	$162.84
Rate for Payer: Multiplan Workers Comp	$162.84
Rate for Payer: Scott and White EPO/PPO	$125.26
Rate for Payer: Superior Health Plan EPO	$34.07

SUTURE DYNACORD

Facility

$178.50

Hospital Charge Code	8512490
Hospital Revenue Code	272
Rate for Payer: Cash Price	$157.08

SUTURE DYNACORD

Facility

$178.50

Hospital Charge Code	8512490
Hospital Revenue Code	272
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$116.02
Rate for Payer: Aetna Commercial	$98.18
Rate for Payer: Amerigroup CHIP/Medicaid	$16.06
Rate for Payer: BCBS of TX Blue Advantage	$53.55
Rate for Payer: BCBS of TX Blue Essentials	$64.26
Rate for Payer: BCBS of TX PPO	$71.40
Rate for Payer: Cash Price	$157.08
Rate for Payer: Multiplan Auto	$116.02
Rate for Payer: Multiplan Commercial	$116.02
Rate for Payer: Multiplan Workers Comp	$116.02
Rate for Payer: Scott and White EPO/PPO	$89.25
Rate for Payer: Superior Health Plan EPO	$24.28

SUTURE DYNACORD SGL BLUE W/MO-7 NDLE 222066

Facility

$509.62

Hospital Charge Code	145427
Hospital Revenue Code	272
Rate for Payer: Cash Price	$448.47

SUTURE DYNACORD SGL BLUE W/MO-7 NDLE 222066

Facility

$509.62

Hospital Charge Code	145427
Hospital Revenue Code	272
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$331.25
Rate for Payer: Aetna Commercial	$280.29
Rate for Payer: Amerigroup CHIP/Medicaid	$45.87
Rate for Payer: BCBS of TX Blue Advantage	$152.89
Rate for Payer: BCBS of TX Blue Essentials	$183.46
Rate for Payer: BCBS of TX PPO	$203.85
Rate for Payer: Cash Price	$448.47
Rate for Payer: Multiplan Auto	$331.25
Rate for Payer: Multiplan Commercial	$331.25
Rate for Payer: Multiplan Workers Comp	$331.25
Rate for Payer: Scott and White EPO/PPO	$254.81
Rate for Payer: Superior Health Plan EPO	$69.31

SUTURE, ENDOSCOPIC OVERSTITCH 2-0 POLYPROPYLENE -- DHF

Facility

$331.79

Hospital Charge Code	81999021
Hospital Revenue Code	272
Min. Negotiated Rate	$29.86
Max. Negotiated Rate	$215.66
Rate for Payer: Aetna Commercial	$182.48
Rate for Payer: Amerigroup CHIP/Medicaid	$29.86
Rate for Payer: BCBS of TX Blue Advantage	$99.54
Rate for Payer: BCBS of TX Blue Essentials	$119.44
Rate for Payer: BCBS of TX PPO	$132.72
Rate for Payer: Cash Price	$291.98
Rate for Payer: Multiplan Auto	$215.66
Rate for Payer: Multiplan Commercial	$215.66
Rate for Payer: Multiplan Workers Comp	$215.66
Rate for Payer: Scott and White EPO/PPO	$165.90
Rate for Payer: Superior Health Plan EPO	$45.12

SUTURE, ENDOSCOPIC OVERSTITCH 2-0 POLYPROPYLENE -- DHF

Facility

$331.79

Hospital Charge Code	81999021
Hospital Revenue Code	272
Rate for Payer: Cash Price	$291.98

SUTURE, ETHIBOND EXTRA GRN BR 2 CARDIO 30'''' OS-4 -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, ETHIBOND GRN BR 0 CARDIO 30'''' SH -- DHF

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, ETHIBOND GRN BR 0 CARDIO 36'''' MH,MH -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$185.49
Rate for Payer: Aetna Commercial	$156.95
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: BCBS of TX Blue Advantage	$85.61
Rate for Payer: BCBS of TX Blue Essentials	$102.73
Rate for Payer: BCBS of TX PPO	$114.15
Rate for Payer: Cash Price	$251.13
Rate for Payer: Multiplan Auto	$185.49
Rate for Payer: Multiplan Commercial	$185.49
Rate for Payer: Multiplan Workers Comp	$185.49
Rate for Payer: Scott and White EPO/PPO	$142.68
Rate for Payer: Superior Health Plan EPO	$38.81

SUTURE, ETHIBOND GRN BR 0 CLOSURE 30'''' CT-1 -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

SUTURE, ETHIBOND GRN BR 0 CLOSURE 30'''' CT-2 -- DHF

Facility

$285.37

Hospital Charge Code	81941403
Hospital Revenue Code	272
Min. Negotiated Rate	$25.68
Max. Negotiated Rate	$185.49
Rate for Payer: Aetna Commercial	$156.95
Rate for Payer: Amerigroup CHIP/Medicaid	$25.68
Rate for Payer: BCBS of TX Blue Advantage	$85.61
Rate for Payer: BCBS of TX Blue Essentials	$102.73
Rate for Payer: BCBS of TX PPO	$114.15
Rate for Payer: Cash Price	$251.13
Rate for Payer: Multiplan Auto	$185.49
Rate for Payer: Multiplan Commercial	$185.49
Rate for Payer: Multiplan Workers Comp	$185.49
Rate for Payer: Scott and White EPO/PPO	$142.68
Rate for Payer: Superior Health Plan EPO	$38.81

SUTURE, ETHIBOND GRN BR 2-0 CARDIO 30'''' SH -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, ETHIBOND GRN BR 2-0 CARDIO 36'''' MH,MH -- DHF

Facility

$147.62

Hospital Charge Code	81940207
Hospital Revenue Code	272
Min. Negotiated Rate	$13.29
Max. Negotiated Rate	$95.95
Rate for Payer: Aetna Commercial	$81.19
Rate for Payer: Amerigroup CHIP/Medicaid	$13.29
Rate for Payer: BCBS of TX Blue Advantage	$44.29
Rate for Payer: BCBS of TX Blue Essentials	$53.14
Rate for Payer: BCBS of TX PPO	$59.05
Rate for Payer: Cash Price	$129.91
Rate for Payer: Multiplan Auto	$95.95
Rate for Payer: Multiplan Commercial	$95.95
Rate for Payer: Multiplan Workers Comp	$95.95
Rate for Payer: Scott and White EPO/PPO	$73.81
Rate for Payer: Superior Health Plan EPO	$20.08

SUTURE, ETHIBOND GRN BR 2-0 CARDIO 36'''' SH,SH -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, ETHIBOND GRN BR 3-0 CARDIO 36'''' RB-1,RB-1 -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Min. Negotiated Rate	$24.85
Max. Negotiated Rate	$179.46
Rate for Payer: Aetna Commercial	$151.85
Rate for Payer: Amerigroup CHIP/Medicaid	$24.85
Rate for Payer: BCBS of TX Blue Advantage	$82.83
Rate for Payer: BCBS of TX Blue Essentials	$99.39
Rate for Payer: BCBS of TX PPO	$110.44
Rate for Payer: Cash Price	$242.96
Rate for Payer: Multiplan Auto	$179.46
Rate for Payer: Multiplan Commercial	$179.46
Rate for Payer: Multiplan Workers Comp	$179.46
Rate for Payer: Scott and White EPO/PPO	$138.04
Rate for Payer: Superior Health Plan EPO	$37.55

SUTURE, ETHIBOND GRN BR 3-0 CARDIO 36'''' RB-1,RB-1 -- DHF

Facility

$276.09

Hospital Charge Code	81940405
Hospital Revenue Code	272
Rate for Payer: Cash Price	$242.96

SUTURE, ETHIBOND GRN BR 5 CARDIO 4-30'''' V-40 -- DHF

Facility

$642.60

Hospital Charge Code	81941551
Hospital Revenue Code	272
Min. Negotiated Rate	$57.83
Max. Negotiated Rate	$417.69
Rate for Payer: Aetna Commercial	$353.43
Rate for Payer: Amerigroup CHIP/Medicaid	$57.83
Rate for Payer: BCBS of TX Blue Advantage	$192.78
Rate for Payer: BCBS of TX Blue Essentials	$231.34
Rate for Payer: BCBS of TX PPO	$257.04
Rate for Payer: Cash Price	$565.49
Rate for Payer: Multiplan Auto	$417.69
Rate for Payer: Multiplan Commercial	$417.69
Rate for Payer: Multiplan Workers Comp	$417.69
Rate for Payer: Scott and White EPO/PPO	$321.30
Rate for Payer: Superior Health Plan EPO	$87.39

SUTURE, ETHILON BLK MONO 3-0 CUTICULAR 30'''' PSLX -- DHF

Facility

$234.19

Hospital Charge Code	81941452
Hospital Revenue Code	272
Min. Negotiated Rate	$21.08
Max. Negotiated Rate	$152.22
Rate for Payer: Aetna Commercial	$128.80
Rate for Payer: Amerigroup CHIP/Medicaid	$21.08
Rate for Payer: BCBS of TX Blue Advantage	$70.26
Rate for Payer: BCBS of TX Blue Essentials	$84.31
Rate for Payer: BCBS of TX PPO	$93.68
Rate for Payer: Cash Price	$206.09
Rate for Payer: Multiplan Auto	$152.22
Rate for Payer: Multiplan Commercial	$152.22
Rate for Payer: Multiplan Workers Comp	$152.22
Rate for Payer: Scott and White EPO/PPO	$117.10
Rate for Payer: Superior Health Plan EPO	$31.85

Know your out-of-pocket cost for care.

All Charges